ED Thoracotomy Instructions Getting Into the Chest: 1. Bilateral finger thoracotomies • 4th or 5th intercostal space • Scalpel - clamp - finger 2. Extend cut from sternum - bed • Curve along rib • Scalpel through skin and subcutaneous tissue • Scissors through intercostal muscles 3. Cut through sternum • Scissors or saw 4. Open chest with rib spreaders • Put U of spreaders towards U Inside the Chest: 5. Deliver Heart • Right mainstream intubation • Cut midline longitudinal incision • Evacuate clots/blood • Apply pressure to wounds • Stop if: Asystole and no tamponade 6. Apply clamp/pressure to bleeding • Ex: visible bleeding vessels, lung tissue 7. Compress aorta • Insert OG tube to identify esophagus • Run hand along ribs until feel aorta • Compress with fingers against spine 8. Cardiac Massage • 2 flat hands • Clapping motion apex - base • Heart held horizontal Dr. Sarah Foohey @SarahFoohey #Thoracotomy #Instructions #procedure #emergency #trauma #checklist #thoracic
